椎基底动脉延长扩张症的CTA和HR-MRI血管壁成像比较

doi:10.3969/j.issn.1673-5765.2018.04.010

摘要/Abstract

摘要：

目的探讨高分辨率磁共振成像（high-resolution magnetic resonance imaging，HR-MRI ）在椎基底动脉延长扩张症（vertebrobasilar dolichoectasia，VBD）诊断中的作用，并对HR-MRI血管壁序列和计算机断层扫描血管成像（computed tomography angiography，CTA）进行比较。方法回顾性分析2014年2月-2015年9月在我院影像科同时完成CTA和HR-MRI检查并确诊为VBD的 25例患者的影像和临床资料，分析和比较CTA和HR-MRI在VBD诊断中的价值。结果在基底动脉脑桥处直径、最大直径及长度的测量上，CTA和HR-MRI具有较好的一致性及可重复性[组内相关系数（intraclass correlation coefficient，ICC）=0.913，P＜0.001；ICC=0.951，P＜0.001； ICC=0.929，P＜0.001]；但是，在偏移度测量上，CTA和HR-MRI的一致性强度为较强[加权Kappa系数 =0.773，95%可信区间（confidence interval，CI）0.606～0.941，P＜0.001]。通过HR-MRI可准确测得椎动脉颅内段长度为左侧（32.02±6.29）mm，右侧（36.66±6.76）mm。HR-MRI检出5例合并基底动脉斑块的患者及2名合并椎动脉夹层的患者。结论 HR-MRI和CTA在VBD的诊断上具有非常好的一致性和可重复性。HR-MRI 作为一种无创检查，在研究VBD病变血管壁特点、检查有无合并其他血管病变及鉴别疾病病因方面，具有较高的诊断价值。

文章导读： 本文探讨了计算机断层扫描血管成像和高分辨率磁共振成像在椎基底动脉延长扩张症诊断上的一致性，为以后椎基底动脉延长扩张症研究提供了新的思路。

关键词: 椎基底动脉延长扩张症; 计算机断层扫描血管造影; 高分辨率磁共振成像

Abstract:

Objective To investigate the role of high-resolution magnetic resonance imaging (HR-MRI) in the diagnosis of vertebrobasilar dolichoectasia, and to compare HR-MRI vascular wall imaging sequence with computed tomography angiography (CTA). Methods The imaging and clinical data of 25 patients who were diagnosed with vertebrobasilar dolichoectasia and underwent CT/CTA as well as HR-MRI during hospitalization during Feb. 2014 to Sep. 2015 were analyzed retrospectively. The study aimed to compare CT/CTA and HR-MRI according to the established criteria and explore the further value of HR-MRI vessel wall imaging. Results Comparison of CTA and HR-MRI revealed very good consistency of the measured diameter at mid-pons [intraclass correlation coefficient (ICC)=0.913, P <0.001], maximum diameter (ICC=0.951, P <0.001) and length of the BA (ICC=0.929, P <0.001). The consistency intensity of CTA and HRMRI was stronger concerning the lateral position [weighted kappa coefficient=0.773, 95% confidence interval (CI) 0.606-0.941, P <0.001]. The length of the intracranial segment of the vertebral artery can be accurately measured by HR-MRI, which was (32.02±6.29) mm on the left side and (36.66±6.76) mm on the right side. There were 5 patients combined with basilar artery plaque and 2 patients with vertebral artery dissection were detected by HR-MRI. Conclusion CT/CTA and HR-MRI demonstrate a very good consistency and reproducibility in the diagnosis of VBD. As a non-invasive examination, HR-MRI has high value in detecting the vascular wall characteristics of VBD, checking whether there are combined with other vasculopathy and identifying the causes of the disease.

Key words: Vertebrobasilar dolichoectasia; Computed tomography angiography; Highresolution magnetic resonance imaging

李韶雅, 王一峰, 徐曼曼, 张鑫, 周飞, 李敬伟, 徐运. 椎基底动脉延长扩张症的CTA和HR-MRI血管壁成像比较[J]. 中国卒中杂志, 2018, 13(04): 344-349.

LI Shao-Ya, WANG Yi-Feng, XU Man-Man, ZHANG Xin, ZHOU Fei, LI Jing-Wei, XU Yun. A Comparision of CT Angiography and High Resolution-MRI Vessel Wall Imaging of Vertebrobasilar Dolichoecta-sia[J]. Chinese Journal of Stroke, 2018, 13(04): 344-349.

参考文献

[1] PICO F，LABREUCHE J，AMARENCO P.

Pathophysiology，presentation，prognosis，and

management of intracranial arterial dolichoectasia[J].

Lancet Neurol，2015，14（8）：833-845.

[2] IKEDA K，NAKAMURA Y，HIRAYAMA T，et al.

Cardiovascular risk and neuroradiological profiles

in asymptomatic vertebrobasilar dolichoectasia[J].Cerebrovasc Dis丆2010丆30乮1乯丗23-28.

[3] PICO F丆LABREUCHE J丆TOUBOUL P J丆et al.

Intracranial arterial dolichoectasia and its relation

with atherosclerosis and stroke subtype[J]. Neurology丆

2003丆61乮12乯丗1736-1742.

[4] INCE B丆PETTY G W丆BROWN R D J R丆et al.

Dolichoectasia of the intracranial arteries in patients

with first ischemic stroke丗a population-based

study[J]. Neurology丆1998丆50乮6乯丗1694-1698.

[5] PASSERO S G丆ROSSI S. Natural history of

vertebrobasilar dolichoectasia[J]. Neurology丆2008丆

70乮1乯丗66-72.

[6] UBOGU E E丆ZAIDAT O O. Vertebrobasilar

dolichoectasia diagnosed by magnetic resonance

angiography and risk of stroke and death丗a cohort

study[J]. J Neurol Neurosurg Psychiatry丆2004丆75

乮1乯丗22-26.

[7] PICO F丆LABREUCHE J丆HAUW J J丆et al.

Coronary and basilar artery ectasia are associated

results from an autopsy case-control study[J]. Stroke丆

2016丆47乮1乯丗224-227.

[8] SCHIEVINK W I丆TORRES V E丆WIEBERS D

O丆et al. Intracranial arterial dolichoectasia in

autosomal dominant polycystic kidney disease[J]. J

Am Soc Nephrol丆1997丆8乮8乯丗1298-1303.

[9] TOYOSHIMA Y丆EMURA I丆UMEDA Y丆et

al. Vertebral basilar system dolichoectasia with

marked infiltration of IgG4-containing plasma

cells丗a manifestation of IgG4-related disease?[J].

Neuropathology丆2012丆32乮1乯丗100-104.

[10] GIANNANTONI N M丆BROCCOLINI A丆

FRISULLO G丆et al. Neurofibromatosis type 1

associated with vertebrobasilar dolichoectasia and

pontine ischemic stroke[J]. J Neuroimaging丆2015丆25

乮3乯丗505-506.

[11] YU Y L丆MOSELEY I F丆PULLICINO P丆et al.

The clinical picture of ectasia of the intracerebral

arteries[J]. J Neurol Neurosurg Psychiatry丆1982丆45

乮1乯丗29-36.

[12] SAMIM M丆GOLDSTEIN A丆SCHINDLER

J丆et al. Multimodality imaging of vertebrobasilar

dolichoectasia丗clinical presentations and imaging

spectrum[J]. Radiographics丆2016丆36乮4乯丗1129-1146.

[13] YUAN Y J丆XU K丆LUO Q丆et al. Research progress

on vertebrobasilar dolichoectasia[J]. Int J Med Sci丆

2014丆11乮10乯丗1039-1048.

[14] SMOKER W R丆PRICE M J丆KEYES W D丆et al.

High-resolution computed tomography of the basilar

artery丗1. Normal size and position[J]. AJNR Am J

Neuroradiol丆1986丆7乮1乯丗55-60.

[15] MATSUKAWA H丆SHINODA M丆FUJII M丆et al.

Basilar dolichoectasia and the spontaneous intradural

vertebral artery dissection[J]. Brain Inj丆2016丆30乮1乯丗

90-94.

[16] FLEMMING K D丆WIEBERS D O丆BROWN R D

J R丆et al. The natural history of radiographically

defined vertebrobasilar nonsaccular intracranial

aneurysms[J]. Cerebrovasc Dis丆2005丆20乮4乯丗270-

279.

[17] NAKATOMI H丆SEGAWA H丆KURATA A丆et al.

Clinicopathological study of intracranial fusiform and

dolichoectatic aneurysms丗insight on the mechanism

of growth[J]. Stroke丆2000丆31乮4乯丗896-900.

[18] JUNG S C丆KIM H S丆CHOI C G丆et al. Quantitative

analysis using high-resolution 3t mri in acute

intracranial artery dissection[J]. J Neuroimaging丆

2016丆26乮6乯丗612-617.

[19] LEE N J丆CHUNG M S丆JUNG S C丆et al.

Comparison of high-resolution mr imaging

and digital subtraction angiography for the

characterization and diagnosis of intracranial artery

disease[J]. AJNR Am J Neuroradiol丆2016丆37乮12乯丗

2245-2250.

[20] TAKANO K丆YAMASHITA S丆TAKEMOTO K丆et

al. MRI of intracranial vertebral artery dissection丗

evaluation of intramural haematoma using a black

blood丆variable-flip-angle 3D turbo spin-echo

sequence[J]. Neuroradiology丆2013丆55乮7乯丗845-851.

[21] PICO F丆LABREUCHE J丆SEILHEAN D丆et al.

Association of small-vessel disease with dilatative

arteriopathy of the brain丗neuropathologic

evidence[J]. Stroke丆2007丆38乮4乯丗1197-1202.

[22] GUTIERREZ J丆SACCO R L丆WRIGHT C B.

Dolichoectasia-an evolving arterial disease[J]. Nat

Rev Neurol丆2011丆7乮1乯丗41-50.

[23] FORSTER A丆KERL H U丆WENZ H丆et al.

Fluid attenuated inversion recovery vascular

hyperintensities possibly indicate slow arterial

blood flow in vertebrobasilar dolichoectasia[J]. J

Neuroimaging丆2015丆25乮4乯丗608-613.

[24] 搈昸丆.巙桬丆庨.梡丆摍. 捙.沲.撪抜揑夝朥妛

尋媶媦懘.彴堄.[J]. 夝朥壢妛.揥丆2007丆13乮2乯丗

119-120.